Aim: To evaluate the three therapy strategies including surgical therapy, hormonal therapy, and combined treatment for the management of endometriosis Study design: A multicentric randomized control trial Place and Duration: This study was conducted in 6 different hospitals of Pakistan, Muhammad Medical and Dental College Ratanabad Mirpurkhas, Social Security Landhi Hospital Karachi, Sindh Government CDF Hospital , Bilawal Medical College for Boys Jamshoro, Ghulam Muhammad Mahar Medical College Sukkur, Bahria International Hospital Karachi, Sandeman Provincial Hospital Quetta Pakistan Pakistan from June 2020 to June 2021. Methodology: The study included 360 participants with genital endometriosis. The age of the patients ranged from 18 years to 45 years. All the patients did not have any previous surgical intervention. The patients were randomly treated with one of the three treatments. A laparoscopic evaluation was done after three months of hormonal and combined therapy. Re-evaluation of surgically treated patients was done after 5 to 6 months. Stage of endometriosis, recurrence of symptoms, and the rate of pregnancy were noted in the re-evaluation phase of the study. Results: The overall cure rate of all types of endometriosis was 56.11% after every regimen of treatment. The cure rate after treatment from combined therapy was 60%. Those treated exclusively by hormone therapy showed a cure rate of 54.17%. A total of 54.17% of patients were cured exclusively by surgical treatment. The rate of recurrence was lowest in the patients given combined therapy. Dyspareunia and dysmenorrhea were significantly reduced. The overall rate of pregnancy was 53% to 64%. The rate of pregnancy was not different among all the groups. Conclusion: After giving hormonal therapy, surgical treatment, and combined treatment, it has been noticed that recurrence was lowest in the combined medical and surgical treatment group. The rate of pregnancy had also got better after all the means of treatment. The highest rate of cure was achieved by combined therapy. Keywords: Endometriosis, laparoscopy, hormone therapy, combined treatment, infertility, recurrence

Introduction: The goal of prenatal care is to improve maternal and fetal outcomes and identify and manage high-risk patients early. Antenatal surveillance, lifestyle change, nutritional supplements, and pharmaceutical therapy are current strategies for preventing pre-eclampsia, which is the precursor to eclampsia. Aim: To determine the prevalence of pre-eclampsia and eclampsia in unbooked pregnant women. Methodology: The study included 295 unbooked primigravida and multigravida women. Participants with any other confirmed medical conditions, such as persistent hypertension, diabetes, thyroid abnormalities, or known renal illness, were excluded from the study. Complete blood count, liver function tests, renal function tests, coagulation profile, and 24-hour urine for protein were all done on the study population. All of the patients were treated according to the department’s standard procedure. Proteinuria was detected using a urine dipstick, a detailed urine report, or a 24-hour urinary protein test. Pre-eclampsia was identified with blood pressure monitoring. Study design: A cross-sectional study. Place and Duration: This study was conducted at Sohail Trust Hospital Karachi, Pakistan from November 2020 to November 2021. Results: The majority of the patients, 135 (45.76 %), were between 31 to 40 years of age. The average gestational age was 25.14± 4.67 weeks. The average gravidity was 3.56 ± 5.65. The average parity was 2.34± 0.67. The average height was 158.67 cm, with a margin of error of 15.67 cm. The average weight was 70.6±6.65 kilograms. The average BMI was 30.76 kg/m2. Pre-eclampsia and eclampsia were found in 40 (13.55 %) and 25 (8.4 %) in unbooked pregnant women respectively. Conclusion: According to this study, pre-eclampsia and eclampsia are much more common in unbooked pregnant women. So, to improve the fetomaternal outcome, we recommend that national awareness programs be established in which pregnant women are encouraged and emphasized for early antenatal care, accurate dating, and early detection of maternal disorders that can threaten pregnancy and its outcome.

Objectives: To compare the results after performing cartilage tympanoplasty and temporalis fascia tympanoplasty. Study Design: Analytical/Observational study. Setting: Two different hospitals. Social Security Landhi Hospital Karachi and Al-Tibri Medical College & Hospital Malir Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations after taking antibiotics. Age ranges between 18 to 40 years. Patients were divided into two groups, group-I and group-II. In group-I, temporalis fascia tympanoplasty performed under microscope with post aural approach and in group-II, tragal cartilage tympanoplasty performed with the oto-endoscope via permeatal approach. Observed and compare the results of both procedure after 1 day, after 1 week, after 1 month and after 2 months. Variables were bleeding, pain, hearing assessment with pure tone audiometry (PTA) in which air conduction, bone conduction and air-bone gap (AB-gap) measured, Vomiting, vertigo and duration of surgery. Weber test done in all patients on very next day after surgeries in both groups to exclude the damage of vestibulo-cochlear system. Integrity of grafted tympanic membrane examined with oto-endoscope. Results: Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Vomiting and vertigo not found after tympanoplasty in both groups which indicate the safety of vestibular system. There was no blood soaked guaze seen after tympanoplasty in group-II (cartilage tympanoplasty). Bleeding was less in group-II as compare to group-I. 37 patients out of 38 had intact grafted tympanic membrane in group-I while all (38) patients had intact grafted tympanic membrane in group-II. Mean duration of surgery was 65.1 +3.7 minutes in group-II (cartilage tympanoplasty) and mean duration of surgery was 82.0 + 5.6 minutes in group-I (temporalis fascia tympanoplasty). P value was <0.001 is significant. Duration of surgery was less in group-II. Hearing was also improved in both groups after tympanoplasty. Post-operated AB-gap reduction seen in all patients of both groups. Conclusion: Results of both temporalis fascia and cartilage tympanoplasty were almost same but cartilage tympanoplasty is better because it consumed less time, less post-operated bleeding and perception of pain were also less.

Objectives: To compare assessment of hearing by PTA and status of tympanic membrane by oto-endoscope, pre-operative and post-operative tympanoplasty. Study Design: Retrospective/ Comparative study. Setting: Two different hospitals in Karachi. 1-Social Security Landhi Hospital Karachi. 2- Al-Tibri medical College & Hospital, Old Thana, Malir, Karachi. Period: July 2017 to June 2018. Material & Methods: 76 patients were included for this study with both genders who had dry tympanic membrane perforations. Age ranges between 18 to 40 years. Made two groups A (pre-operative and B (post-operative). In group-A, examined tympanic membrane perforations. 45 patients had small size (25%) perforations, 15 medium size (50%) and 16 subtotal (75%). Hearing assessment done by Pure tone Audiometry (PTA). After 1. 2 and 3 months post-tympanoplasty, examined grafted tympanic membrane and compared pre-operated status of tympanic membrane with post-operated status of tympanic membrane. PTA done after 3 months and compared it with pre-operated PTA. Results: Examination of tympanic membrane before tympanoplasty performed, perforations noted in all patients with different sizes in their tympanic membrane. PTA (pure tone audiometry) advised before tympanoplasty to all patients. Weber test performed on 1st post-operated day, it was lateralized towards operated ear which indicate the safety of inner ear. Post-operated 1, 2 and 3 months examined tympanic membrane with oto-endoscope. Intact grafted tympanic membrane seen in 70 patients after 1 months. After 2 months 72 patients had intact grafted tympanic membrane and after 3 months 73 patients out of 76 patients had intact grafted tympanic membrane. PTA also advised after 3 months of tympanoplasty and compared it with pre-operated pure tone audiometry (PTA). Air conduction (AC) decreased 15.39dB after tympanoplasty. AB-gap reduction 13.95dB seen in 73 patients which showed hearing improvement. P value is < 0.001 significant. Conclusion: Tympanoplasty is a good and safe procedure for hearing improvement by reduction of AB-gap as well as provide protection of middle ear mucosa from infections due to closure of perforations of tympanic membranes.

Objective: To compare the levels of serum zinc, serum calcium and serum magnesium between preeclamptic patients and normal pregnant women. Study Design: Retrospective/ Comparative study. Setting: Department of Obs & Gynae, Social Security Landhi Hospital Karachi. Period: March 2019 to October 2019. Material & Methods: 90 pregnant women were included for this research. Patients were divided into two groups randomly, Group-A (Pre-eclampsia) and Group-B (Normal pregnancies). 45 patients were included in each group. At the time of antenatal booking, in Group-A patients we advised CBC, LFT`s, Urine for Albumin, HbS. Ag, Anti HCV Antibody, Fasting blood sugar, serum zinc, serum calcium, serum magnesium level and ultra sound for fetal wellbeing while in Group-B patients only CBC, Fasting blood Sugar, Urine D/R, HbS Ag, Anti HCV antibody, serum calcium, serum zinc and serum magnesium level and ultra sound for fetal wellbeing. Compared mean age and B.M.I. of patients, mean gestational age, mean systolic and diastolic blood pressure, mean of serum zinc level, serum calcium level and serum magnesium level in both groups. Results: Serum Zinc, Serum Calcium and Serum Magnesium levels were significantly low in pre-eclamptic patients as compared with normal pregnant women. Conclusion: Mean serum zinc, calcium and magnesium level were low in pre-eclamptic patients.